fracture healing srinath
TRANSCRIPT
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FRACTURE HEALING
D SRINATH FINAL YEAR M.B.B.S
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FRACTURE Disruptions of bone tissue FRACTURE HEALINGIt is a complex process that requires
recruitment of appropriate cells(fibroblasts, macrophages, chondroblasts, osteoblasts, osteoclasts) and subsequent expression of the appropriate genes(genes that control matrix production and organisation, growth factors, transcription factors)
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Bone regeneration is the appropriate termBone healing is unique that there is no scar
at the place of impact
THREE PHASES OF HEALING
Inflammatory phase
Reparatory phase
Remodelling phase
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INFLAMMATORY PHASE
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REPARATORY PHASE
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REMODELLING PHASE
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Methods of fracture healing
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INDIRECT This is most common method of fracture
healingPOP is based on this
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Hunter’s stagingStage of impact
• from the moment of impact to the fracture of the bone
Stage of induction
• the cells involved in the callus formation is induced by BMP, low oxygen tension, bioelectric
Stage of inflammation
• hemorrhage, angiogenesis, cellular infilatration
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Stage of hematoma
• blood from torn vessel collects• Hematoma formation• organised with fibrous tissue, cartilage
stage of callus
• intercellular matrix formation with calcium salt deposition
stage of remodelling
• woven bone to lamellar bone• haversion remodelling• normal cortical bone structure attained
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FROST STAGINGstage of hematoma
stage of granulation tissue
stage of callus
stage of remodelling
stage of modelling
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DIRECT BONE HEALINGhealing by primary intentionno callus formationanatomically reduced and fixed open procedure with plates and screwshealing occurs by osteon - osteon hook up by
direct haversion remodellingOsteoclasts cut the bone, osteoblasts -paste the bone
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DISTRACTION HISTEOGENESIShealed by gradual distraction of osteomies
clinical union – fracture site is stable and pain free
radiological union – x ray shows bone trabeculae and cortical bone at fracture site
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FACTORS INFLUENCING FRACTURE HEALINGSYSTEMIC FACTORS Age
Children heals earlier than adultsSex
sameActivity level
Adequate immobilisationNutrional status
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Hormone factorsGrowth hormoneCorticosteroidsSex hormonesThyroid and parathyroidcalcitonin
DiseasesDMAnemiaScabiesneuropathies
Vitamin deficienciesA,D,C,K
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Drugs and other substancesNsaidsPhenytoinTetracyclinesNicotine alcohol
HypoxiaSystemic growth factorsEnvironmental temperatureCNS trauma
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LOCAL FACTORSFactors independent of injury, treatment and complicationType of bone – flat and cancellous bone
quick healingAbnormal bones – radiation necrosis,
infection, tumors
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Factors depending on injuryDegree of local damage – compound #, comminute#, velocity of injury, ,
type and locationpattern of # - spiral<oblique<transverse
loss of bonesoft tissue interposition
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Factors depending on treatmentImplantsExtent of surgical traumaDegree of rigidity of external and internal fixation
Extent of contact between fragments
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Factors associated with complicationsInfectionVenous stasisMetal allergy
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Failure of fracture healing
Delayed unionNon union(hypertrophic and atrophic)Fibrous union
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THANK YOU